A 45-year-old black man presents for evaluation of a recent flare of long-standing atopic dermatitis (AD). The patient’s medical history is significant for hyperlipidemia and hypertension, which are being treated with oral medications. For several decades, the patient considered his condition to be “tolerable” and “somewhat well-controlled” with topical therapies and ample exposure to sunlight (he was a construction worker in Florida).

Three years ago, he relocated to Pennsylvania and experienced a severe flare during the winter months. He was subsequently treated with intramuscular triamcinolone and a medium-potency topical corticosteroid. The condition abated but flared again 3 months later. He received a second triamcinolone injection and was prescribed oral cyclosporine (3 mg/kg). His dermatitis improved on this regimen, but after 1 year his serum creatinine level has risen above the normal range.

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